- Definition
Common upper respiratory illness seen in children that is characterized by a barky cough. It is usually self-resolving, but can also progress to respiratory distress and death.
- Pathophysiology
If a virus is the cause of croup, it infects the mucosal epithelium lining the nasal cavity and pharynx. It then spreads along to the larynx and trachea. The infection then causes an inflammation attack to the subglottic airway, area below the vocal cords. There are rigid tracheal rings around it, so this inflammation causes severe narrowing of the airway. If the child becomes agitated from this, there can be further obstruction of treachea below the rings. If the culprit are bacteria, thick pus, ulcers, and abscesses can develop at the subglottic area.
- Symptoms & Signs
- Patient's age is usually 6 months - 3 years.
- Nasal discharge, congestion, coryza
- After 1-2 days: fever, hoarseness, barky cough, stridor.
- Restlessness/anxiety/agitation
- Indrawing (suprasternal/subcostal/intercostal)
- Best Imaging Modality
-
- Gold Standard: Radiography of the airway
Radiographic evaluation of chest is important if:
- Diagnosis uncertain (ie. many convincing differentials
- Severe symptoms, does not respond to treatment
- Suspicion of foreign body aspiration
- Recurrent croup
If positive for croup, radiograph will characteristically show Steeple sign, so named because the subglottic narrowing looks like a steeple. Lateral view may show overdistention of the hypopharynx on inspiration.
- Treatment
-
Mild Croup:
- Humidity: steam in shower, mist
- Resolve fever (symptomatic treatment)
- Hydration
- Cold night air
Moderate-Severe Croup:
- Nebulized epinephrine: IV: 0.5mL/kg of 1mg/mL through nebulizer over 15mins
- Dexamethasone: steroids; 0.6mg/kg, max 16mg. Oral/IV/IM, whichever is the most accessible.
- Supplementary humidified O2
- Fluid support
References
- Woods CR. Croup: Clinical features, evaluation, and diagnosis. UpToDate.com. 2022. (accessed on July 2022).